Introduction:

Peripheral ulcerative keratitis (PUK) is a serious inflammatory condition that affects the cornea, the clear front surface of the eye. This comprehensive article aims to provide a thorough understanding of peripheral ulcerative keratitis, including its causes, symptoms, diagnosis, and treatment options.

Causes of Peripheral Ulcerative Keratitis:

PUK is often associated with underlying systemic diseases and immune-mediated conditions. The following are common causes of PUK:

• Rheumatoid arthritis: PUK is a known ocular manifestation of rheumatoid arthritis, an autoimmune disease that causes inflammation of the joints.
• Systemic lupus erythematosus: PUK can occur in individuals with systemic lupus erythematosus, a chronic autoimmune disorder that affects multiple organs, including the skin and joints.
• Wegener's granulomatosis: This rare autoimmune disease affects blood vessels and causes inflammation in various organs, including the eyes.
• Polyarteritis nodosa: PUK may develop in individuals with polyarteritis nodosa, a systemic vasculitis that affects small- and medium-sized arteries.
• Sjögren's syndrome: PUK can be seen in individuals with Sjögren's syndrome, an autoimmune disorder characterized by dry eyes and dry mouth.
• Other systemic diseases: Certain infections, such as herpes simplex virus and varicella-zoster virus, as well as inflammatory bowel disease and Behçet's disease, can also lead to PUK.

Symptoms of Peripheral Ulcerative Keratitis:

The symptoms of PUK may include:

• Redness and inflammation of the eye
• Eye pain or discomfort
• Blurred vision or vision loss
• Sensitivity to light (photophobia)
• Excessive tearing or discharge from the eye
• Corneal thinning or perforation (in severe cases)

Diagnosis of Peripheral Ulcerative Keratitis:

The diagnosis of PUK involves a comprehensive eye examination and evaluation of the underlying systemic condition. The following diagnostic tests may be performed:

• Visual acuity test: This assesses the clarity of vision using an eye chart.
• Slit-lamp examination: A specialized microscope is used to examine the cornea and surrounding structures in detail.
• Ocular surface evaluation: The health of the ocular surface, tear film, and eyelids is assessed.
• Systemic evaluation: Blood tests, such as rheumatoid factor, antinuclear antibodies, and other specific autoantibodies, may be done to identify underlying systemic diseases.

Treatment Options for Peripheral Ulcerative Keratitis:

The treatment of PUK aims to control inflammation, prevent corneal thinning or perforation, and manage the underlying systemic disease. Treatment options may include:

• Topical corticosteroids: These anti-inflammatory medications are often prescribed to reduce ocular inflammation and promote corneal healing.
• Immunosuppressive therapy: In severe cases or when PUK is associated with a systemic autoimmune disease, systemic immunosuppressive medications may be used to control inflammation.
• Lubricating eye drops: Artificial tears or other lubricating eye drops help relieve dryness and soothe the ocular surface.
• Surgical intervention: In cases of corneal thinning or perforation, surgical procedures such as amniotic membrane transplantation or corneal grafting may be necessary to repair the damaged cornea.

Management Strategies and Follow-up Care:

Managing PUK requires a multidisciplinary approach involving ophthalmologists and rheumatologists or other relevant specialists. The following strategies are important for successful management:

• Close monitoring: Regular follow-up visits are necessary to assess the response to treatment, monitor ocular health, and adjust medications as needed.
• Systemic disease management: Treating and managing the underlying systemic disease is crucial to prevent PUK recurrence or progression.
• Lifestyle modifications: Avoiding factors that exacerbate ocular inflammation, such as environmental irritants or contact lens use, can help prevent further damage to the cornea.
• Patient education: Educating patients about their condition, treatment options, and the importance of compliance with medications and follow-up visits is essential for optimal management.

Conclusion:

Peripheral ulcerative keratitis is a serious condition that requires prompt diagnosis and appropriate management. Understanding the underlying causes, recognizing the symptoms, and implementing the appropriate treatment options can help preserve vision and improve the overall prognosis for individuals with PUK.

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